Hospital Readmissions After Catheter Ablation for Atrial Fibrillation Among Patients with Heart Failure in the USA - European Medical Journal
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Hospital Readmissions After Catheter Ablation for Atrial Fibrillation Among Patients with Heart Failure in the USA

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EMJ Cardiology 8.1 2020 Feature Image
Authors:
*Anshul Parulkar,1 Fabio V. Lima,1 Kevin Kennedy,2 Wasiq Sheikh,1 Esseim Sharma,1 Antony Chu1
Disclosure:

The authors have declared no conflicts of interest.

Citation
EMJ Cardiol. ;8[1]:45-46. Abstract Review No. AR1.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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BACKGROUND AND AIMS

Atrial fibrillation (AF) and congestive heart failure coexist frequently,1 and ablation is increasingly utilised as a safe and effective treatment modality for achieving sinus rhythm in patients with heart failure.2,3 While other studies have examined risk factors for post-ablation readmission, rates of hospital readmission after catheter ablation for AF among patients with an established diagnosis of heart failure is still largely unknown.4 In this study, the authors aimed to assess the causes and rates of 30-day readmission among patients with heart failure undergoing catheter ablation, compared to medical therapy for AF in the USA.

MATERIALS AND METHODS

The authors utilised the 2016 Nationwide Readmissions Database (NRD) to screen patients with a diagnosis of heart failure and AF using the 10th Revision of International Classification of Disease (ICD-10) codes. Index admission was defined as hospital admission for management of either heart failure or AF.

Patients who subsequently underwent catheter ablation for AF were grouped separately from those treated medically for AF. Patients who died during the 30 days following discharge, those who were admitted for heart failure or AF management prior to the index admission, and those who had a prior admission for any reason within 30 days of index admission, were all excluded. Thirty-day readmissions were assessed for both the ablation and medical therapy only groups.

RESULTS

The 2016 NRD was screened for all admissions with a diagnosis of heart failure and AF. The final analytic cohort included 749,776 patients (national estimate of 1,421,673) with heart failure and AF. In total, 2,204 patients underwent catheter ablation, compared to 747,572 patients who underwent medical therapy. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% versus 20.1%; p<0.001). In the catheter ablation cohort, 55% of all readmissions were related to cardiac events. Among this group, heart failure (40%) and arrhythmia (36%) were the most common cardiac causes for readmission (Figure 1).

Figure 1: Cardiac causes of 30-day hospital readmission in patients with heart failure and atrial fibrillation that underwent catheter ablation.

CONCLUSION

In a contemporary nationwide analysis of patients with heart failure and AF, patients treated with catheter ablation for AF compared to medical therapy had fewer 30-day readmissions after discharge from index hospitalisation. Among patients treated with catheter ablation, the most common causes for readmissions were congestive heart failure exacerbation and arrhythmia.

References
Zafrir B et al. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14,964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39(48):4277-84. Marrouche NF et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417-27. Hunter RJ et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure. Circ Arrhythm Electrophysiol. 2014;7:31-8. Garg J et al. Predictors of 30-day readmissions after catheter ablation for atrial fibrillation in the USA. J Interv Card Electrophysiol. 2019;55(3):243-50.